Cleft Lip Surgery: Diagnosis, Procedure, & Recovery

Diagnosis & Evaluations Before Cleft Lip Repair

Prior to cleft lip treatment, several important diagnoses and evaluations are typically conducted to ensure the best possible outcome for the patient. These assessments help the doctor to understand the severity of the cleft, the overall health of the patient, and any potential complications that might arise during or after surgery. Here are some of the key evaluations: 

• Physical Examination: A thorough physical examination is conducted to assess the size, shape, and extent of the cleft lip. The surgeon examines the cleft and surrounding tissue to determine the best surgical approach.
• Imaging Studies: Various imaging studies might be performed, including ultrasound, magnetic resonance imaging (MRI), and/or computed tomography (CT) scans. These imaging techniques provide detailed information about the structures of the face, allowing the surgical team to plan the procedure more effectively.
• Nutritional Assessment: Nutrition is an important factor in the healing process. Infants with cleft lips may have difficulty feeding due to the gap in the lip. Nutritional assessments help ensure that the patient is receiving adequate nutrition before and after surgery.
• Dental Evaluation: Depending on the severity of the cleft, there might be associated dental abnormalities. A dental evaluation can identify any potential issues with the teeth and jaw which may influence the surgical repair plan in the future. 
• Speech Evaluation: Cleft lips can sometimes affect speech development. A speech evaluation helps identify any potential speech-related concerns that may need to be addressed in conjunction with surgical repair.
• Anesthesia Evaluation: If the patient is an infant or child, an anesthesia evaluation is conducted to assess their suitability for anesthesia during surgery. An anesthesiologist reviews the child’s medical history to ensure his/her safety during the procedure.

Once the assessments are done, the surgeon will present the treatment and repair plan to the parents, disclose the risks and complications, and also give an idea of what to expect after surgery. The family is educated and informed well enough to have realistic expectations and prepare themselves for the challenges and care involved with cleft lip repair. 

Types of Cleft Lip Repair

There are a few different techniques used for cleft lip repair, depending on the severity and type of cleft. The two main types of cleft lip repair surgery are the Millard Rotation-Advancement Technique (also known as the “Millard Technique”) and the Tennison-Randall Technique. These techniques differ in their approaches to closing the cleft and achieving a more natural lip appearance. 

• Millard Technique or Rotation-Advancement Technique: In the Millard cleft lip repair technique, a rotational flap is created along the medial segment of the cleft, and an advancement flap is created along the lateral segment of the cleft lip. This technique allows the surgeon to create the philtrum and access the nasal tip cartilage for proper reconstruction. 
• Tennison-Randall Technique or Triangular Flap Technique: This technique involves creating a triangular flap originating from the cleft side and closing at the non-cleft side of the lip. This type of flap allows wider clefts to be repaired successfully and is easier to perform, even by a less experienced surgeon. There are several limitations of this technique, such as the inability to create a philtrum, access nasal cartilage, and modify the technique. 

Besides the above-mentioned techniques, some other methods are also used to improve the outcomes of cleft lip repair surgery, such as a lip-taping regimen, nasal elevator, and nasal-alveolar molding (NAM) device. These methods are non-invasive and can dramatically enhance the shape and appearance of the child’s upper lip, nose, and mouth.  

Benefits of Cleft Lip Repair

Cleft lip repair surgery offers numerous benefits to individuals born with cleft lips. These benefits extend beyond the cosmetic aspect and greatly impact both physical and emotional well-being. Here are some of the key benefits of cleft lip repair:

• Improved Appearance: One of the most noticeable benefits is the improvement in the appearance of the lip. Cleft lip repair surgery aims to create a more natural and symmetric lip contour, which restores the normal facial profile and allows the lips to develop with age. 
• Enhanced Functionality: Cleft lips can affect speech, feeding, and even breathing in some cases. Repairing the cleft can improve these functions. A repaired lip helps create a proper seal for breastfeeding and bottle feeding, facilitating better nutrition during infancy. Additionally, a properly aligned lip can contribute to improved speech development as the child grows.
• Reduced Risk of Infections: A cleft in the lip can make it difficult to clean and maintain proper oral hygiene. Repairing the cleft reduces the gaps and crevices that can harbor bacteria, thus decreasing the risk of infections and related dental problems.
• Easier Medical Care: Cleft lip repair at an early age can simplify medical care and reduce the need for frequent visits to specialists. It can also minimize the need for corrective surgeries later in life. 
• Support Normal Growth and Development: Addressing the cleft early in life supports normal growth and development of facial structures. This can contribute to balanced facial features as the child grows.
• Prevention of Complications: Cleft lips can be associated with complications such as speech difficulties, dental problems, and ear infections. Repairing the cleft helps prevent or minimize these potential issues.
• Long-Term Quality of Life: The long-term benefits of cleft lip repair extend into adulthood. Patients who have undergone successful cleft lip repair are more likely to lead fulfilling lives, engage in social activities, pursue education and career opportunities, and have positive relationships.

It should be noted that cleft lip repair surgery alone may not be sufficient for all patients born with a cleft lip and/or palate. Future surgical interventions, speech therapy, orthodontic treatments, etc., may be required. 

Preparation Before Cleft Lip Surgery

Several pre-operative instructions are given to the patient’s family to ensure his/her safety, comfort, and the surgery’s success. The specific instructions might vary based on the treatment plan and the child’s health. Some common instructions given by the surgeon may include the following:

• The pediatrician will examine the child a week before the surgery to ensure that he/she is healthy enough for the procedure. They will go over the child’s medical history and allergies and also ask the parents to stop giving the child certain medications a week before the surgery. 
• Specific eating and drinking instructions are also given to the child’s parents based on his/her age. This includes that no milk formula or cow’s milk is given to the child at least 6 hours before the surgery. 
• Breastfeeding is allowed four hours beforehand, and clear liquids up to 3 hours before the procedure. 
• No solid foods or baby food should be given to the child after midnight on the day of the surgery. 
• Give the prescribed medications to the child prior to surgery as instructed. 
• Bathe the child the night before or the morning of the surgery using an antibacterial soap to reduce the risk of infection. 
• Dress the child in comfortable and loose-fitted clothes, as they will be easier to remove when the child has to change into a hospital gown. 
• Trim the child’s nails short to reduce the risk of scratching or injuring himself/herself during the recovery period. 
• Keep a comfort item, like a favorite toy or blanket, for the child to soothe him/her before and after the surgery. 
• Bring all the necessary documents, including identification, insurance card, test reports, etc., for admission and hassle-free surgery. 

If the child becomes ill (has a cough, cold, or fever), notify the surgeon and his/her team right away so that the surgery can be postponed. 

Cleft Lip Repair Procedure

The procedure for cleft lip repair involves several steps, and the specific details may vary based on the surgeon’s technique, the severity of the cleft, and the individual patient’s needs. 

In the case of unilateral cleft, only one surgery is required. But if the child has bilateral cleft and it’s extensive, two surgeries may be performed. One side of the cleft is corrected first, and the second side is corrected a few weeks later. The most common procedure to repair a cleft lip is the Millard technique, whose steps are explained below in detail. 

• Intravenous sedation or general anesthesia may be used to numb the patient and/or make them fall asleep. 
• The skin is cleaned and sterilized, and markings are done for anatomical landmarks and incisional lines. 
• The surgeon makes incisions on both sides of the cleft, starting from the base of the nose and extending toward the corners of the mouth. These incisions create flaps of tissue on either side of the cleft.
• The flaps of tissue are carefully elevated, creating access to the underlying muscle and tissue layers.
• The surgeon then rotates and advances the flaps toward the center of the lip to close the gap. This process helps recreate the natural contour of the upper lip and restore symmetry.
• The tissue layers of the flaps are sutured together, closing the cleft and creating a continuous, well-aligned lip contour. Special attention is given to preserving Cupid’s bow, the double curve of the upper lip.
• The surgeon carefully evaluates the appearance of the repaired lip, making any necessary adjustments to ensure symmetry and an aesthetically pleasing result. Fine-tuning of the lip’s shape and alignment is performed as needed.
• Once the lip is repaired and sutured, the surgeon closes the incisions with stitches or sutures that will dissolve over time.
• A sterile dressing or bandage might be applied to the surgical site to protect it and facilitate proper healing. The patient is transferred to a recovery room where his/her vitals are monitored until the effects of anesthesia wear off. 

The entire cleft lip repair procedure may take around 1 to 2 hours or more, depending on the severity of the condition and the type of repair done. In the case of bilateral cleft lip repair, a second surgery will be performed similarly or through a different technique to correct the deformity in the upper lip completely. 

What to Expect After Cleft Lip Surgery?

Immediately after the surgery, expect the child to feel mild pain. He/she might be irritated, and the treated area will be swollen and bruised. 

Soft splints or cuffs are placed around the child’s arm to prevent them from touching his/her lip. This can further make the child uncomfortable and agitated. It is safe to feed breastmilk or formula shortly after the surgery, but there might be some difficulty in doing so. 

An intravenous catheter will be attached to the child to give him/her fluids until he/she can drink. In most cases, hospitalization is not needed after cleft lip surgery. Thus, the child is discharged after a few hours, and the parents are given detailed instructions for post-operative care. 

Results & Recovery Timeline After Cleft Lip Treatment

The results of cleft lip surgery will take some time to become clearly visible due to the bruising, swelling, and redness around the lips. As the child heals, the results will become more apparent. The results and recovery timeline will be as follows: 

• In the 1st week, there will be significant swelling, bruising, and discomfort around the surgical site. The child needs to be given pain medications every 6 hours or so. The parents will also face some difficulty in trying to feed the child. 
• Up to the 2nd and 3rd weeks, the swelling, bruising, and redness will start to subside. The doctor will remove the stitches (if used), or the sutures may start to dissolve in the second week. The surgical site will still appear swollen, and the child may still have some difficulty eating and drinking normally. 
• Within 4 to 6 weeks, the appearance of the lips will continue to improve, and the incision area will start to feel less tight. This will provide overall comfort to the child, and he/she will be able to eat and drink normally. 
• The incision scar will start to heal after 1 month of surgery and may take around a year to fade. As children have better healing abilities, there are chances that the scar will become almost invisible, and the child’s speech and feeding will improve significantly. 

As the recovery process will take around 2 to 4 weeks, the parents will have to be extra attentive to care for the child to ensure a smooth recovery and successful outcome. The outcome will be determined based on how well the parents take care of the child. Therefore, it is important to follow the doctor’s instructions. 

Risks & Complications of Cleft Lip Surgery

Undergoing cleft lip repair surgery is critical for the child’s development and quality of life. But that doesn’t mean that the surgery is risk-free. There are several risks and complications associated with the procedure. Thus, the surgeon will explain them in detail, and the parents are asked to sign the consent form to confirm that they fully understand the procedure and its potential risks and complications. 

• The surgical site may get infected due to poor hygiene and care. The child may need stronger antibiotics or additional treatment (or surgery) to treat the infection. 
• While surgeons usually follow a minimally invasive approach for reduced scarring, in some cases, the wound may heal abnormally, leading to keloid or hypertrophic scarring. 
• The results may not be symmetrical. To prevent this, it’s important to get the surgery done by an experienced surgeon. 
• In some children, the wound may heal slowly due to nutritional deficiencies or some other reasons. Poor wound healing can also increase the chances of wound dehiscence(reopening of the wound).  
• The child may have an allergic reaction to the anesthesia and have breathing difficulties. 
• In some cases, the facial nerves may get damaged, due to which the child may temporarily or permanently lose- sensations, the ability to control facial muscles around the lips, or auditory responses. 
• While cleft lip repair can improve speech and feeding, some children may still experience mild difficulties that require speech therapy or specialized feeding techniques.

Other than these, there are some side effects of cleft lip surgery, such as bleeding, bruising, swelling, and redness around the lips, nose, and cheeks. Typically, the surgeon takes the potential complications into consideration while planning the procedure and recommends certain measures to reduce the risk of developing these complications. Still, some complications may develop, and the child may require additional care. 

Post-Op Care Tips Recommended After Cleft Lip Repair

Once the cleft lip is repaired, both parents will have to take a proactive approach to the child’s care to ensure a successful outcome of the surgery and prevent future complications. The recommended tips required, but are not limited to the following: 

• Physical Restraint: The child needs to be kept gently restrained 24×7 in the first 2-3 weeks until the wound heals. Children usually keep their hands in their mouths, which should be avoided at all costs. Try using a blanket or soft arm restraints for a few weeks. 
• Eating & Drinking Habits: Feeding the child after surgery will be the most difficult task. Depending on the age of the child, he/she may have to relearn to drink and swallow food. 
• Diet & Nutrition: The surgeon will decide the best way to feed the child after surgery. Typically, parents will be advised to feed the child soft or liquid foods. Avoid feeding foods that have large chunks, lumps, or pieces in them, and also avoid hard and crunchy foods. Use a spoon or rubber-tipped syringe to ensure they don’t tear the stitches.
• Protect the Wound: To ensure that the wound heals properly, parents need to pay special attention to oral hygiene and cleanliness. Use a gauze pad dipped in plain water or alcohol-free mouthwash mixed with water to clean the gums (teeth if he/she has any). 
• Give Medicine: The child needs to take the prescribed medications as directed by the surgeon. Generally, antibiotics and painkillers are given to the child. As the child cannot tell if he/she is in pain, follow the surgeon’s instructions regarding the dosages to keep the child pain-free and comfortable. 
• Distract the Child & Avoid Rough Play: In the initial stages, it’s important for parents to keep the child distracted by reading books or watching movies with them. When the child starts to feel better, he/she would like to play, but the parents need to be careful to play gently and avoid activities that can strain the facial muscles. 
• Limit Sun Exposure: Don’t take the child outside without using proper sun protection. Try to avoid sun exposure as much as possible, as UV rays can cause pigmentation or darkening around the lips, especially the scar. 
• Take Regular Follow-ups: Throughout the recovery period, it’s important to make regular follow-ups with the doctor for optimal healing. The doctor will monitor the child’s recovery and adjust medications as required. 

Parents are also asked to look out for the signs of infection or other post-op complications, which include trouble breathing, wheezing, skin discoloration, unresponsive, or seizure-like activity. 

Cleft Lip Surgery Cost in India

In India, cleft lip surgery costs range from Rs. 40,000 to Rs. 60,000 or more. The overall cost of cleft lip repair depends on multiple factors and varies from one patient to another. The key factors that influence cleft lip surgery cost in India are

• The type and severity of the cleft (unilateral, bilateral, complete, or incomplete).
• The proposed treatment plan and technique used for cleft lip repair. 
• The surgeon’s consultation and operating fee. 
• Diagnostic tests and evaluations before and after the surgery. 
• The choice of hospital or clinic and its location. 
• Hospital-related expenses, from admission to discharge. 
• Post-surgery care, medicines, and follow-ups. 

To get a specific cost estimate for cleft lip surgery, get in touch with Pristyn Care. 

Does Health Insurance Cover Cleft Lip Surgery?

A cleft lip is a serious medical condition, and its treatment is deemed medically necessary under all circumstances. Thus, the expenses of the clef lip surgery are covered by health insurance. 

However, there are several requisites that parents need to follow to get their child’s treatment covered under health insurance. These requisites include:

• The parents must have a family floater policy that allows them to cover their children. This can be done by informing the insurer about the childbirth and paying an additional premium for the coverage. 
• The child should be at least 90 days old. 
• The parents can buy a maternity health insurance plan as they provide cleft lip insurance coverage for the child from the day he/she is born. 

To learn more about the available insurance plans for newborn children, it’ll be best to talk to the health insurance provider.